To Örebro University

BACKGROUND: Sarcopenic obesity (SO) is characterized by the presence of both obesity and sarcopenia and is related to disability and loss of independence in older adults. The extent to which time spent in light physical activity (LPA), or moderate-to-vigorous physical activity (MVPA) is associated with SO risk in older adults remains unclear. The aim of this study was (a) to examine the association between the level of adherence to recommended amounts of MVPA and the risk of SO in older adults and (b) to determine whether time spent in LPA is associated with SO risk independently of time spent in MVPA.

METHODS: This cross-sectional study involved 862 community-dwelling older adults (58% women; aged 65-79 years) from four European countries. Accelerometer-determined time in MVPA was categorized as follows: inactive (< 75 min/week), moderately active (75-149 min/week), active (150-299 min/week) and highly active (≥ 300 min/week). Time in LPA was expressed in tertiles. The outcome measure SO risk was determined based on appendicular lean mass, waist circumference, handgrip strength and the 5-times sit-to-stand test. Odds ratios (OR) with a 95% confidence interval (95% CI) of high SO risk across levels of MVPA and LPA were determined by binary logistic regression adjusted for the level of systemic inflammation (high-sensitivity C-reactive protein) and dietary protein intake.

RESULTS: Compared to the inactive group, ORs of having a high SO risk were about 50%-80% lower, depending on the MVPA level, with the largest risk reduction in the highly active group (OR: 0.23, 95% CI: 0.13-0.39; p < 0.05). The likelihood of having a high SO risk was significantly lower among the highly active group compared to the active group (OR: 0.50; 95% CI: 0.33-0.77; p < 0.05). More time in LPA was associated with a significantly lower likelihood of having high SO risk (highest vs. lowest tertile: OR: 0.52, 95% CI: 0.30-0.89; p < 0.05) only in participants with low amounts of MVPA. In contrast, LPA was not associated with SO risk among participants meeting the MVPA recommendation.

CONCLUSIONS: MVPA is strongly associated with a lower likelihood of having a high SO risk in older adults, independently of the level of systemic inflammation and intakes of dietary proteins. LPA is related to SO risk in sedentary older adults, which supports the promotion of physical activity regardless of intensity for mitigating SO.

Objectives: To determine how clustered metabolic risk based on a validated continuous metabolic syndrome risk score is associated with objectively assessed time in sedentary behaviors (SB) in physically active and inactive older adults, while considering adherence to healthy eating habits.

Design: Cross-sectional study.

Setting and participants: The study comprises 871 community-dwelling older adults (age 65-79 years) recruited from four European countries.

Measurements: Daily times spent in SB and physical activity (PA) were assessed by accelerometers (Actigraph GT3X) for a week. Waist circumference, triglycerides, HDL-cholesterol, mean arterial blood pressure, fasting glucose and insulin were determined, and a continuous metabolic syndrome risk score (cMSy) was generated using principal component analysis. Healthy eating habits were assessed by food record. General linear models stratified by adherence to PA guidelines (active/inactive) were used to examine differences in cMSy across tertiles of time in SB (Low, Medium, High) with adjustment for covariates, including healthy eating habits.

Results: A significantly (p < 0.05) lower cMSy was observed among older adults in the low SB tertile compared to medium and high SB tertiles, with no difference between the latter tertiles. The favorable effect of low amounts of SB on cMSy was indicated in both active and inactive groups, and regardless of healthy eating habits. Further, being active was related to a more favorable cMSy across all SB tertiles.

Conclusion: Low amounts of time spent in SB are related to a lower metabolic syndrome risk regardless of adherence to PA guidelines and healthy eating habits in older adults, supporting guidelines targeting limited amounts of SB alongside engagement in moderate-to-vigorous PA for promotion of metabolic health.

Facioscapulohumeral muscular dystrophy (FSHD) is an inherited muscle disease characterized by weakness and muscle wasting. In the absence of available treatments, exercise training has emerged as a potential strategy to attenuate muscle tissue deterioration. However, little is known about the impact of chronic exercise on degenerative events and regenerative capacity in FSHD muscle. Muscle biopsies were obtained from 16 FSHD patients before and after a 24 week training program combining aerobic-, strength- and high-intensity exercise (Control; n = 8, Training; n = 8). Histochemical and immunohistochemical approaches were applied to assess histopathological signs, markers of regeneration, inflammatory infiltrates and satellite cell content. Muscle telomere length was measured as an indicator of the remaining regenerative capacity. The proportion of muscle fibres expressing developmental myosins and centralized myonuclei was not exacerbated after the intervention. Similarly, no alterations were observed in the number of inflammatory infiltrates (CD68+ cells). Alongside muscle hypertrophy in slow (P = 0.022) and fast fibres (P = 0.022 and P = 0.008), satellite cell content increased specifically in fast fibres (+75 %, P = 0.015), indicating a functional satellite cell pool in FSHD muscle. Importantly, exercise training was not associated with a shortening of muscle telomere length, suggesting that muscle cell turnover was not accelerated despite an expansion of the satellite cell pool. Our findings suggest that combined exercise training elicits beneficial muscular adaptations without impairing important indicators of skeletal muscle regenerative capacity in patients with FSHD. KEY POINTS: A 24 week combined exercise training program is a safe and well-tolerated strategy to attenuate skeletal muscle deterioration in facioscapulohumeral muscular dystrophy (FSHD) patients. Markers of histopathology, muscle fibre regeneration and inflammatory infiltrates were not exacerbated following exercise training in FSHD muscle. Here, we show novel data that exercise training in FSHD patients induced muscle fibre hypertrophy and triggered an expansion of the satellite cell pool specifically in fast fibres. Exercise training in these patients is not associated with a shortening of muscle telomere length thereby indicating a preserved capacity for muscle regeneration.

Strenuous exercise can result in disruption of intestinal barrier function and occurrence of gastrointestinal symptoms. The aim of this exploratory study was to elucidate systemic effects of increased intestinal permeability after high-intensity exercise. Forty-one endurance-trained subjects performed a 60-min treadmill run at 80% VO2max. Small intestinal permeability was measured as urinary excretion ratio of lactulose/rhamnose (L/R). Blood, saliva and feces were analyzed for gut barrier and immune-related biomarkers. The exercise challenge increased several markers of intestinal barrier disruption, immune function and oxidative stress. We found a negative correlation between L/R ratio and uric acid (r = -0.480), as well as a positive correlation between the L/R ratio and fecal chromogranin A in male participants (r = 0.555). No significant correlations were found between any of the markers and gastrointestinal symptoms, however, perceived exertion correlated with the combination of IL-6, IL-10 and salivary cortisol (r = 0.492). The lack of correlation between intestinal permeability and gastrointestinal symptoms could be due to minor symptoms experienced in lab settings compared to real-life competitions. The correlation between L/R ratio and uric acid might imply a barrier-protective effect of uric acid, and inflammatory processes due to strenuous exercise seem to play an important role regarding physical exhaustion.

Background: There is scarcity of data exploring the dynamics of barriers to changing physical activity (PA) and eating habits during a lifestyle intervention in a primary care setting. The aim of the present study was to investigate barriers to lifestyle change before and during a primary care lifestyle intervention in adults with different sociodemographic backgrounds.

Methods: Barriers to healthy eating and PA were assessed in 114 adults (age = 55 +/- 9 years) using a questionnaire before inclusion in the intervention. During the lifestyle intervention, factors perceived as obstacles to reach goals for PA and healthy eating habits were collected using focus group interviews in a sub-sample of 25 adults and analyzed using thematic analysis.

Results: At least 1 barrier to changing eating and PA habits was reported in 65% and 67% of the population, respectively, without differences due to sex, place of birth, and educational level. Before entering the lifestyle intervention, intrapersonal factors including lack of willpower and lack of enjoyment were the dominant barriers to PA and healthy eating, irrespective of place of birth, sex, and education level. In contrast, environmental factors such as lack of support from family and work-related constraints emerged as important barriers to overcome during the action phase of the lifestyle intervention.

Conclusions: The present study highlights the dynamics of barriers to changing PA and eating habits in a primary care lifestyle intervention, emphasizing the need for barrier assessment during the different phases of an intervention to tailor support activities for successful lifestyle behavioral change.

INTRODUCTION: The extent to which additional health benefits of accumulating twice the minimum amount of time in moderate-to-vigorous physical activity (MVPA) affects indicators of physical function in older adults is unclear. Therefore, the aim of the present study was to assess indicators of physical function in older adults who accumulate at least 150 but less than 300 min/week of MVPA compared to those accumulating at least 300 min/week.

METHODS: Indicators of physical function, including handgrip strength, 5 times sit-to-stand test (5-STS), squat jump and 6-min walk test (6MWT) were assessed in a sample of 193 older men (n = 71, 67 ± 2 years), and women (n = 122, 67 ± 2 years), who all accumulated at least 150 weekly minutes of MVPA. Time in MVPA was assessed by accelerometry during 1 week and engagement in muscle strengthening activities (MSA) was assessed by self-report. Protein intake was assessed by a food-frequency-questionnaire. Participants were classified as physically active (≥150 but <300 min of MVPA per week) or as highly physically active (≥300 min of MVPA per week).

RESULTS: Factorial analysis of variance revealed that older adults accumulating at least 300 min of MVPA per week had a significantly (p < 0.05) better 6MWT performance and overall physical function compared to the less active group. These findings remained significant after further adjustment for MSA, sex, waist circumference and protein intake. In contrast, no significant differences in indicators of muscle strength were observed between the two groups.

DISCUSSION: Adherence to twice the recommended minimum amount of weekly MVPA time is related to a better physical function, evidenced by a better walking performance compared to adherence to the minimum weekly amount of MVPA. This finding emphasizes the benefits of accumulating daily MVPA beyond the minimum recommended amount to optimize the ability to perform activities of daily living, thus reducing the burden of physical disability and related health-care costs.

Ageing limits growth capacity of skeletal muscle (e.g. in response to resistance exercise), but the role of satellite cell (SC) function in driving this phenomenon is poorly defined. Younger (Y) (~ 23 years) and older (O) men (~ 69 years) (normal-weight BMI) underwent 6 weeks of unilateral resistance exercise training (RET). Muscle biopsies were taken at baseline and after 3-/6-week training. We determined muscle size by fibre CSA (and type), SC number, myonuclei counts and DNA synthesis (via D₂O ingestion). At baseline, there were no significant differences in fibre areas between Y and O. RET increased type I fibre area in Y from baseline at both 3 weeks and 6 weeks (baseline: 4509 ± 534 µm², 3 weeks; 5497 ± 510 µm² P < 0.05, 6 weeks; 5402 ± 352 µm² P < 0.05), whilst O increased from baseline at 6 weeks only (baseline 5120 ± 403 µm², 3 weeks; 5606 ± 620 µm², 6 weeks; 6017 ± 482 µm² P < 0.05). However, type II fibre area increased from baseline in Y at both 3 weeks and 6 weeks (baseline: 4949 ± 459 µm², 3 weeks; 6145 ± 484 µm² (P < 0.01), 6 weeks; 5992 ± 491 µm² (P < 0.01), whilst O showed no change (baseline 5210 ± 410 µm², 3 weeks; 5356 ± 535 µm² (P = 0.9), 6 weeks; 5857 ± 478 µm² (P = 0.1). At baseline, there were no differences in fibre myonuclei number between Y and O. RET increased type I fibre myonuclei number from baseline in both Y and O at 3 weeks and 6 weeks with RET (younger: baseline 2.47 ± 0.16, 3 weeks; 3.19 ± 0.16 (P < 0.001), 6 weeks; 3.70 ± 0.29 (P < 0.0001); older: baseline 2.29 ± 0.09, 3 weeks; 3.01 ± 0.09 (P < 0.001), 6 weeks; 3.65 ± 0.18 (P < 0.0001)). Similarly, type II fibre myonuclei number increased from baseline in both Y and O at 3 weeks and 6 weeks (younger: baseline 2.49 ± 0.14, 3 weeks; 3.31 ± 0.21 (P < 0.001), 6 weeks; 3.86 ± 0.29 (P < 0.0001); older: baseline 2.43 ± 0.12, 3 weeks; 3.37 ± 0.12 (P < 0.001), 6 weeks; 3.81 ± 0.15 (P < 0.0001)). DNA synthesis rates %.d^-1 exhibited a main effect of training but no age discrimination. Declines in myonuclei addition do not underlie impaired muscle growth capacity in older humans, supporting ribosomal and proteostasis impairments as we have previously reported.

Although consumption of fruits and vegetables (FV) is suggested to reduce metabolic risk, there is a paucity of studies taking advantage of objectively assessed physical activity (PA) behaviors when exploring links between FV intake and metabolic syndrome (MetS) in older adults. The aim of the present study was to determine the relationship between FV intake and MetS prevalence in a population of older community-dwelling adults, while considering time spent being sedentary and health-enhancing PA. Prevalence of MetS was determined in a population of 93 men and 152 women (age: 65-70 years). FV intake was determined by self-report and PA behaviors (time spent in moderate-to-vigorous PA (MVPA) and in sedentary) were assessed by accelerometry. Likelihood of having MetS by FV intake was determined using logistic regression with stepwise backward elimination including age, sex, educational level, total energy intake, adherence to MVPA guideline and total sedentary time as covariates. A main finding was that lower FV intakes were significantly related to higher prevalence of MetS (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.03-1.47) after considering potential influences by covariates. Additionally, we found that lower intake of vegetables but not fruits was significantly related to higher prevalence of MetS (OR: 1.47; 95%CI: 1.04-2.07). In conclusion, lower intakes of FV in general, and of vegetables in particular, significantly increased likelihood of MetS, regardless of time spent sedentary and adherence to the MVPA guideline. From a public health perspective, our findings emphasize adequate intakes of FV as an independent contributor to metabolic health status in older adults.

It is hypothesized that healthy diets rich in fruits and vegetables (FV) can modulate the inflammatory status in older adults. However, to determine the actual impact of FV on inflammatory status, adiposity level and objectively assessed physical activity (PA) behaviors need to be considered. The aim of the present study was to explore associations between FV intake and biomarkers of systemic inflammation in older adults. Based on a sample of 233 older adults (65-70 years old), the following inflammatory biomarkers were assessed: C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), IL-10, IL-18, and monocyte chemoattractant protein-1 (MCP-1). FV intake was assessed by self-report, and PA behaviors encompassing time spent sedentary and in moderate-to-vigorous PA (MVPA) were determined using accelerometers. Associations between FV intake and inflammatory biomarkers were analyzed using stepwise linear regression models while adjusting for several covariates, including health-related food groups, adherence to the MVPA guidelines, total sedentary time, and waist circumference. While no significant associations were observed for the total FV intake, the vegetable intake was inversely associated with levels of IL6 (β = -0.15; p &lt; 0.05). In contrast, fruit intake was not associated with any inflammatory biomarker. In conclusion, our findings indicate beneficial associations between vegetable intake and levels of a pro-inflammatory biomarker in older adults, which strengthens public health efforts to promote vegetable-rich diets in older adults to mitigate age-related systemic inflammation.

The role of daily time spent sedentary and in different intensities of physical activity (PA) for the maintenance of muscle health currently remains unclear. Therefore, we investigated the impact of reallocating time spent in different PA intensities on sarcopenia risk in older adults, while considering PA type (muscle strengthening activities, MSA) and protein intake. In a sample of 235 community-dwelling older adults (65-70 years), a sarcopenia risk score (SRS) was created based on muscle mass assessed by bioimpedance, together with handgrip strength and performance on the five times sit-to-stand (5-STS) test assessed by standardized procedures. Time spent in light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), and being sedentary was assessed by accelerometry, and PA type (MSA) by self-report. Linear regression models based on isotemporal substitution were employed. Reallocating sedentary time to at least LPA was significantly (p < 0.05) related to a lower SRS, which remained evident after adjustment by PA type (MSA) and protein intake. Similarly, reallocating time in LPA by MVPA was related to a significantly (p < 0.05) lower SRS. Our results emphasize the importance of displacing sedentary behaviours for more active pursuits, where PA of even light intensities may alleviate age-related deteriorations of muscle health in older adults.